OSPE 1

10 minutes

Mr A, a Malay man, 31 years of age, presented with 2 months of fever and

a skin lesion on his right flank (Figure 1). The skin lesion started as a small
nodule, which after a week became weepy, before drying and developing
a thick black scab. The lesion was painless. At presentation Mr A had had
a fever for 1 week. He had also experienced three episodes of fever in the
past 2 months: each episode lasting 2 weeks, subsiding for 1 week and
occurring again.

Figure 1. The skin lesion at the right flank region

Figure 2. Temperature chart illustrating the patient's fever pattern

A. What further history would you like to obtain from this patient? [16]
History
Justification

B. Define pyrexia of unknown origin. [3]

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C. Enumerate five (5) common causes of pyrexia of unknown origin.
Classify your answer. [5]
1.
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2.
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3.
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4.
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5.
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D. What further investigations would you like to request in this patient?
[5]
Investigations

Justifications

E. What pattern of fever is shown above in Figure 2. Name THREE

possible differential diagnosis. [4]
Pattern :
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Differential diagnosis: 1)
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2)
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3)
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F. Complete the Table 1 below demonstrating other patterns of fever
and their common causes. [6]

Type of fever

Common characteristics Positive aetiology

Table 1

Figure 2. Temperature chart illustrating the patient's relapsing fever

pattern